Primary anaplastic large cell lymphoma of the psoas muscle: a case report and literature review.

Primary anaplastic large cell lymphoma (ALCL) of skeletal muscle is very rare. We report a case of ALCL arising from the left psoas muscle. A 14-year-old girl presented with a large left inguinal tumor. She complained of a 2-month history of left leg pain, which had been exacerbated upon leg extension, and she had become aware of a rapidly growing left inguinal tumor 3 weeks before admission. CT scan and MRI revealed a large tumor arising from the left major psoas muscle and protruding into the inguinal region. In view of the tumor's location and the patient's age, soft tissue tumors such as rhabdomyosarcoma and primitive neuroectodermal tumor were initially considered. However, histopathological examination yielded a diagnosis of anaplastic lymphoma kinase-positive ALCL. The serum level of soluble interleukin-2 receptor was markedly elevated at 50,414 U/ml, and this also strongly suggested ALCL. Although rarely reported, ALCL is an important entity to consider in the differential diagnosis of skeletal muscle tumors in children and young adults.

[Homebound status and life space among Japanese community-dwelling elderly in an urban area].

OBJECTIVES: To examine the relationship between homebound status and physical, mental, social and life space factors among community-dwelling elderly in an urban area. METHODS: A cross-sectional survey was conducted using a mail-in self-administered questionnaire between July and September 2009. The target population comprised 149,991 community residents, aged 65 years and over, living in Setagaya Ward, Tokyo, as of April 2009. "Homebound" was defined as going out (leaving the home) only once a week or less. The respondents were further identified as "type 1" or "type 2" homebound; type 1 included those with a low frequency of outings and low mobility level, and type 2 included those with a low frequency of outings despite having a high mobility level. Questionnaire items encompassed frequency of outings and demographic data, as well as physical, mental, social and life space factors. RESULTS: A total of 103,684 questionnaires were included in the analysis (valid response rate: 69.1%). Among the participants, 3.7% were found to be type 1 homebound and 4.5% were type 2. The older the age group, the higher was the proportion of both types of homebound. Physical and social factors were associated with type 1 homebound, and physical, mental and social factors with type 2. Moreover, regarding the life space factor, poor physical accessibility of the home was associated with type 2 homebound, and less space utilization in daily life was associated with both types. CONCLUSION: It is important for homebound reduction among the elderly to address the physical, mental and social factors that affect homebound status. In addition, assessing the current home environment and expanding the daily living space could also be strategies to reduce homebound prevalence among the elderly. Collaboration with the housing and public transportation sectors is needed to plan a comprehensive homebound reduction strategy.

[Classification of Japanese elderly in an urban area at risk of becoming homebound: knowledge for improving prevention strategies].

OBJECTIVES: This study aimed to assess the living situation and health of elderly people in an urban area of Japan at risk of becoming homebound, so as to tailor measures to prevent or delay this occurring. We identified the prevalence rate of people currently homebound and those at risk, classifying using predictors reported in previous studies. An assessment of physical and cognitive factors affecting each classified group was included. METHODS: The survey targeted 149,991 people aged 65 or older living in Setagaya Ward in Tokyo. Mail-in questionnaires included items to assess respondents' demographic characteristics, physical and mental health conditions, quality of life, activities of daily living, and social lifestyles. We operationally defined people who go out (leave their home) only two or three times a week as the "at-risk" group, and "homebound" was defined as going out only once a week or less. Then we determined the prevalence rates of the homebound and at-risk group. We sub-classified the at-risk group by conducting a cluster analysis using predictors of homebound status reported in previous studies. Then we identified each group's characteristics by comparing mental health and cognitive condition between the groups. RESULTS: Questionnaire responses from those who did not fill out the survey themselves or who failed to fully answer questions on homebound predictors used in the cluster analysis were excluded. Also disregarded were responses from hospital inpatients or residents of elderly care facilities. The final number of respondents included in the analysis was 90,605. The prevalence rate of elderly who were at risk of becoming homebound was found to be 13.0% (n=11,282). Cluster analysis identified five clusters based on instrumental ability of daily living, mental health and cognitive condition: very good condition (46.4%), depressive (23.5%), low cognitive function and depressive (19.6%), low Instrumental Activities of Daily Living (IADL) (6.5%) and very poor condition (3.8%). The very good condition group fared favorably in nearly all aspects assessed in the questionnaire. The depressive group and the low cognitive function and depressive group strongly indicated anxieties about falling or about their future life and included people who went out less frequently compared with the previous year. The low IADL group and the very poor condition group were comparatively old and included a high percentage of people registered as requiring long-term care. CONCLUSION: Based on the particular characteristics of the identified groups, we propose primary strategies to help elderly people who are at risk of becoming homebound: 1) Very good condition group: Identify reasons why their frequency of outings is just two or three times a week, even though they seem to be healthy, and provide assistance with maintaining their current health condition considering those reasons. 2) Depressive group: Prevent physical decline by providing consultations addressing their anxieties about falling. 3) Low cognitive function and depressive group: Intervene in the early stages to address negative cognitive states such as loneliness. 4) Low IADL group: Intervene to help maintain their remaining abilities including cognitive function. 5) Very poor condition group: Ensure maintenance of services or support currently being provided, and have community health care providers and staff monitor health status changes.